About Me

Buford C. Terrell
Controlled substances laws and their consequences have been the center of my professional life for over fifteen years. I host a public interest television program in Houston, “Drugs, Crime, and Politics” , produced by the Drug Policy forum of Texas, and have done so for most of its ten-year history. Before my retirement, I taught a seminar, “Controlled Substances Law” for many years at South Texas College of Law.
In this blog I intend to explore the features and consequences of those laws, especially the unintended consequences, and look at the need for, and possibility of, changing them. Don’t expect a lot of breaking news or current events, although there will be some. My approach will be more historical and theoretical. I hope to get a lot of criticism – good, bad, and otherwise – and to start some good, heated discussions.

Friday, June 14, 2013

If Heroin Were Legal: Part I

If
Heroin Were Legal: Part I

One
of the goals of many drug law reformers is to legalize – that is, remove
criminal penalties for -- the manufacture, distribution, and possession of
heroin.Likewise, one of the often
expressed fears of Drug Warriors is that heroin will be legalized.These conflicting views raise the question:
what would happen if heroin were legal?The answer is two-fold.First,
the changes would be very small.Second,
almost all of those changes would be beneficial.

Answering
this question requires looking at five different aspects: the drugs, the users,
the supply business, regulation and control, and law enforcement.Part I of this essay will examine the drugs
and the users, and Part II will look at the other three issues.

The
Drug:Heroin is not a
unique drug; in fact it is not even unusual.It is a member of the group known as “opiates”, derived from the opium alkaloids,
morphine, codeine, and thebaine.This
group, in addition to morphine and heroin, includes oxycodone and
hydrocodone.The last two are the basis
of most modern prescription painkillers, including OxyCotin, Vicodin, and
Percoset.The opiates are closely
related to the opioids, synthetic compounds designed to act like the opiates,
which include fentanyl, methadone[1], Dilaudid, and Dilantin.The body treats these drugs as virtually
interchangeable.Habitual users move
easily among those drugs, substituting one for another.Experiments at the Federal Narcotic Farm
showed that even the most experienced users could not distinguish between shots
of heroin and morphine.In fact, the
body converts heroin (diacetyl morphine) back into morphine in order for it to
be effective.

The opiates and
opioids together comprise most of medicine’s armentarium against pain.They are employed for everything from Vicodin
for a toothache to morphine for trauma or surgery to fentanyl and OxyCotin for intractable
chronic pain.If heroin loses its legal
mark of Cain, it will simply become a minor, undistinguishable part of that
large group.On the other hand, if
heroin were to magically disappear tomorrow, its users would simply switch to
other opiates.Or worse, as they did
when heroin and morphine almost disappeared when World War II disrupted world
trade, they would change to much more dangerous and deadly drugs like alcohol
or barbiturates.

Users:Opiate users[2] can be placed in several
categories: medical users, experimental or casual users, dependent users, and
compulsive users.Medical users are the
largest group and, under modern medical supervision developed over the last
thirty years, very rarely become problematic users.The next largest group, but still well under
ten percent of the population are the casual and experimental users.These people will experiment with opiates out
of curiosity or continue modest, occasional use for years without becoming
problematic, and fewer than ten percent of them become compulsive users, or “addicts”.

Anyone
using opiates regularly for more than a few days, even under medical
supervision, will develop a physical dependency to the drugs.The body will not function properly without
the drug, and its absence will cause withdrawal, a condition much like a severe
case of the flu, that lasts for about seven days.It is much less severe than withdrawal from
alcohol, benzodiazepines, or barbiturates, which can be fatal.After withdrawal ends, the body returns to
normal without the drug.Much of today’s
confusion about opiates stems from the 1920s, before doctors learned to
distinguish between dependency and addiction.Many medical opiate users develop dependency, but modern practice
includes supervised withdrawal as part of the treatment.

Compulsive
users (a term without the historical and cultural baggage that has accumulated
around the more common “addict”) are those who continue to use the drug in spite
of knowledge that continued use will be harmful to themselves or others and who
cannot resist the impulse to use.The
number of these users is small, probably less than one million in the U. S. –
less than one-third of one per cent of the population.

The
popular view of a drug addict is a street derelict supporting himself by petty
theft, shoplifting, car burglary, or prostitution.However, this addict only appeared in the
1920s and is a creation of drug Prohibition, not of drug use.

Evidence
before passage of the Harrison Act (1914) does not clearly distinguish between
dependent users and compulsive users, but by the early 1920s, the major
features of compulsive use were becoming obvious.First, long-term opiate use has no major
medical consequences; the only significant sequaliae are constipation and the
risk of withdrawal if use stops.Second,
even compulsive users can maintain normal, productive lives if an adequate,
regulated dose is available to them (see the earlier posting on Dr. William
Halsted for an early, well-documented example).

The
impressive sets of evidence support this conclusion.For almost twenty years, the Swiss have
maintained documented addicts on free heroin, with no overdose deaths and a
large decrease in street crime.In the
U. S. methadone maintenance has been used since the mid-1979s with few
problems, although these limited programs have been complicated by having to
exist within a wider regime of blackmarket illegal drugs.England has used heroin maintenance since the
end of World War I except for an interval starting during the Thatcher regime
in the 1970s.This program has had few
problems, but during the time it was suspended, all of the ills of street drugs
– deaths, crime, corruption, violence – emerged only to disappear when
maintenance was resumed.

One
key feature of these programs is that overdose deaths have virtually
disappeared among the participants.

This
discussion of the drugs and their users has set the stage.Part II will examine the effects of
legalization on the supply business, regulation and control, and law
enforcement.

[1]
Methadone was developed in Germany in the 1930s where the government feared
that a war would prevent the importation of morphine for both civilian and
military use.

[2] As
the preceding section of drugs demonstrates, limiting the discussion to only
heroin users would be misleading, or even mistaken.